ABM is excited to partner with The Georgia
Treatment Resisitant Depression Clinic and offer HOPEto
those suffering from TreatmentResistant Depression(TRD).

We are one of the few sites in the nation offering Ketamine
injections, a promising new option for patients with TRD. Additionally, we offer a cutting-edge non-medical treatment for
TRD, Transcranial Magnetic Stimulation (TMS) with the Neurostar system.

Major
depressive disorder (MDD) is common, having a one year prevalence of 6.4% of the US
adult population and a lifetime prevalence approaching 20%, according to the National Institute of Mental Health. A
large number of these patients do not respond to currently available treatments, including the selective serotonin reuptake
inhibitors and the first line antidepressants and eventually result in treatment resistant depression (TRD).

TRD
accounts for approximately 12–20% of those who are diagnosed with depression and sums to annual nearly $50 billion in
additional costs. Usually there is a delay of weeks to months in treatment response with conventional antidepressants even
in cases of successful treatments, which is a major drawback and necessitates the development of faster acting antidepressants.
This is particularly of paramount importance for depressed patients who present with suicidality, a major challenge in TRD.
Thus, there is a clear need to offer innovative, rapidly effective, and longer lasting treatments for patients with TRD.

Patients with moderate to severe depression who have not responded
to at least 2 antidepressant trials of adequate dose and duration are candidates for referral to the TRD Clinic.

Ask your Primary Care Physician, Neurologist, or Psychiatrist to refer you for a one-time consultation by
visiting www.athensbehavioral.com, filling out the brief "TRD Clinic Referral Form," & submitting it electronically.

Our TRD Clinic Patient Coordinator will then call you to schedule the consultation, which is covered by most insurance plans.

Patients
will continue care with their referring Primary Care Physician, Neurologist,
or Psychiatrist. Doctors at our clinic will NOT prescribe
or manage your psychiatric medications but will supply the referring doctor with detailed written treatment recommendations.

If patients choose adjunctive Ketamine or TMS treatments
at our clinic, your doctor will continue to manage your other medications and will receive periodic updates on your progress.

If a patient desires follow-up with a Psychiatrist, wewill be happy to refer you to either a clinician atAthens Behavioral Medicine
or another psychiatrist in the community.

Additional
info on TRD

Recently, Al-Harbi summarized the standard of care, therapeutic
trends, and the challenges involved in patients with TRD. It is important to note that most of the approved antidepressant
medications primarily target the brain monoamine systems (serotonin, norepinephrine, or, in some cases, dopamine) and, unlike
Ketamine which acts ultrarapidly (usually within 2 hours of infusion or even quicker than this), none of these are known to
target the glutamate system which has been implicated as an important therapeutic target based on the recent research in TRD.

In general, the therapeutic options for TRD include two major strategies, that is, augmentation of antidepressant
medication(s) which is done for partial responders and optimization of antidepressant medication(s) which is used for nonresponders.
Before using these strategies, a thorough revision of psychiatric and medical diagnoses is necessary not only to identify
misdiagnoses, if any, but also to identify any medical and psychiatric comorbidities that could contribute to the treatment
resistance. The augmentation strategies involve adding one (or more) agent(s) which is not an antidepressant but may enhance
the effect of the antidepressant. These augmenting agents are lithium, thyroid hormones, buspirone, pindolol, psychostimulants,
atypical antipsychotics, sex hormones, anticonvulsants/mood stabilizers, and dopamine agonists.

In contrast, optimization strategies involve maximization of the dose of the antidepressant for adequate time
and assessment of serum levels of prescribed antidepressants if indicated. It may also involve switching to another antidepressant(s)
(usually from a different class) or using a combination of antidepressants or may include addition of atypical antipsychotics
with antidepressant properties. Adequate dosage and duration (usually 6–8 weeks) and adherence must be allowed for these
psychotropic agents before they are deemed ineffective. If these agents fail, other approaches involve use of somatic therapies
like ECT (electroconvulsive therapy), VNS (vagal nerve stimulation), and rTMS (repetitive transcranial magnetic stimulation).
Use of DBS (deep brain stimulation) in TRD has remained experimental and is usually reserved as last resort for isolated and
utterly resistant cases only. Last but not the least, integrated approaches for TRD involve use of antidepressants together
with other modes of treatment which include ketamine, psychotherapy, risk management strategies, complementary and alternative
medicine (CAM) therapies (including Yoga and mindfulness approaches), and life style changes such as aerobic exercises, stress
management, and vacation. Additionally, use of strategies to manage the side effects of antidepressants and other psychotropic
agents remains important in treating patients with TRD. Despite these existing strategies, TRD still remains a huge public
health burden which includes the burdensome risk of suicide in this population.

Considering
the severity of TRD and scarcity in the availability of effective and relatively faster acting pharmacological and psychological
treatments, it is quite pertinent to look for other treatment options, as sole modality of treatment or as adjunct. It is
encouraging to note that there has been considerable progress in this regard, which includes the newer potential treatment
modalities such as Ketamine and TMS.